Rheumatoid arthritis is a chronic inflammatory condition that mainly affects the joints. Patients usually have general health symptoms such as fatigue, low fever and malaise, in addition to joint symptoms. Many different medications are used to treat rheumatoid arthritis, although a cure is not possible. The goal is chronic management of the disease.
Stomach Ulcers
This is a risk of treatment with nonsteroidal anti-inflammatory medications such as ibuprofen. They are used to alleviate pain, and can also irritate the stomach lining by making it more vulnerable to the damaging effects of stomach acid. This can make the patient more susceptible to ulcer formation.
Increased Bruising
This is also a risk of nonsteroidal anti-inflammatory medications. One of the side effects of these medications is a toxic effect on a component of the blood clotting system known as platelet cells. The patient may bruise easily because of decreased platelet activity.
Increased Risk of Infection
Steroids such as prednisone have an inhibitory effect on cells of the immune system and can weaken the immune system to the point that the patient acquires infections with increased frequency and severity. Immunosuppressant medications such as cyclosporine, azathioprine and cyclophosphamide also have toxic effects on cells of the immune system, and can cause similar infection risk via immune system suppression.
Visual Problems
Visual problems can occur with medications such as hydroxychloroquine. It has a toxic effect on the retina, a component of the eye, and as a result anybody on hydroxychloroquine therapy has to have yearly eye exams to evaluate for damage. Symptoms include blurry vision and problems with night vision. Steroid therapy such as prednisone also put the patient at increased risk of developing cataracts, especially with long-term therapy. These patients can also develop blurry vision and are encouraged to follow up with their physician if steroid therapy is prolonged.
Liver Damage
Quite a few medications that are used in rheumatoid arthritis can cause toxicity to the liver. Nonsteroidal anti-inflammatory drugs such as ibuprofen, hydroxychloroquine, minocycline and sulfasalazine all have direct toxic effects on the liver. Patients can suffer from jaundice, pain in the upper right segment of the abdomen (corresponds to the location of the liver) and sometimes be completely asymptomatic. The physician can usually run some blood tests that show elevated liver enzymes present, clinching the diagnosis.
Bone Marrow Suppression
Many of the rheumatoid arthritis medications can suppress the activity of the bone marrow. The bone marrow is responsible for significant blood component production, which includes cells of the immune system, platelet cells (help with clotting) and red blood cells. As a result, these patients have increased risk of infection with an increased risk of bleeding and bruising, and can suffer from fatigue as well.
References
- The American Journal of Medicine. "Rheumatoid Arthritis: Diagnosis and Management." Majithia V, Geraci S. Volume 120, Issue 11 (November 2007)
- "Kelley's Textbook of Rheumatology, 8th Edition;" Firestein; 2008
- "Cecil Medicine, 23rd Edition;" Goldman; 2007
